Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica
Autor(a) principal: | |
---|---|
Data de Publicação: | 2020 |
Tipo de documento: | Tese |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFSCAR |
Texto Completo: | https://repositorio.ufscar.br/handle/ufscar/14652 |
Resumo: | The literature indicates a strong relationship between musculoskeletal losses and the incidence of type 2 diabetes mellitus (DM2), and it is also unclear whether DM2 affects the passive properties of the musculoskeletal system, increasing the muscle stiffness and impairing the function of these individuals. Objective: To analyze whether concentric and isometric torques can distinguish between individuals with DM2 and peripheral diabetic neuropathy (DPN) from individuals without DM2 with the same age and anthropometric characteristics, and also to analyze the passive torque and passive stiffness in DM2 individuals, with and without NDP at the knee and ankle flexion and extension compared to individuals without DM. Methods: Of the 88 participants, 29 were controls, 59 with DM2 (23 with and 36 without DPN). Glycemic control was determined by HbA1C and DPN by the Michigan Neuropathy Screening Instrument (MNSI). Concentric and isometric torque during knee and ankle flexion and extension were assessed by isokinetic dynamometry and torque suitability by principal component analysis (PCA). The identified variables were further used in a cluster analysis (k-means). Stepwise regression was applied to investigate factors associated with HbA1c and MNSI scores. For passive torque analyses, three groups of men (n=49) of similar age were studied, 17 with DM2 without DPN, 15 with DM2 and DPN, and 17 control subjects without DM2. Knee flexion and extension passive torque as well as ankle dorsiflexion and plantar flexion were assessed on an isokinetic dynamometer, followed by passive torque and passive stiffness calculation. The absence of muscular activity during the tests was determined by electromyography (EMG). Results: Concentric knee flexion and extension and isometric ankle extension torques characterized 88.59% of the individuals, forming Cluster 1 (n=29 controls) and Cluster 2 (n=59 DM2). HbA1c was associated with lower torque and higher IL-6, and MNSI score with lower torque and higher TNF-α and IL-6. Subjects with DM2 and DPN exhibited greater knee extension passive stiffness (p<0.01) as well as increased passive torque and stiffness during dorsiflexion and plantar flexion (p<0.04) at 5o /s when compared to controls and those with DM2 without DPN. Conclusion: Concentric knee and isometric ankle torques discriminated between subjects with and without DM2. However, knee and ankle torque reductions associated with DPN, poor glycemic control, and subclinical inflammation were not sufficiently significant to differentiate between DM2 individuals with and without DPN. Individuals with DM2 and DPN present higher knee and ankle stiffness and passive torque in comparison to those with DM2 without DPN and the controls. The mechanical impairments in ankle viscoelastic structures were most evident and more easily assessed at low speeds. |
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Ferreira, Jean de PaulaSalvini, Tânia de Fátimahttp://lattes.cnpq.br/4391969032505723Serrão, Paula Regina Mendes da Silvahttp://lattes.cnpq.br/2917658715637353http://lattes.cnpq.br/7404427274731262840e33c2-d641-41c5-a7bf-1f2f3a4496112021-07-22T12:28:23Z2021-07-22T12:28:23Z2020-01-20FERREIRA, Jean de Paula. Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica. 2020. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2020. Disponível em: https://repositorio.ufscar.br/handle/ufscar/14652.https://repositorio.ufscar.br/handle/ufscar/14652The literature indicates a strong relationship between musculoskeletal losses and the incidence of type 2 diabetes mellitus (DM2), and it is also unclear whether DM2 affects the passive properties of the musculoskeletal system, increasing the muscle stiffness and impairing the function of these individuals. Objective: To analyze whether concentric and isometric torques can distinguish between individuals with DM2 and peripheral diabetic neuropathy (DPN) from individuals without DM2 with the same age and anthropometric characteristics, and also to analyze the passive torque and passive stiffness in DM2 individuals, with and without NDP at the knee and ankle flexion and extension compared to individuals without DM. Methods: Of the 88 participants, 29 were controls, 59 with DM2 (23 with and 36 without DPN). Glycemic control was determined by HbA1C and DPN by the Michigan Neuropathy Screening Instrument (MNSI). Concentric and isometric torque during knee and ankle flexion and extension were assessed by isokinetic dynamometry and torque suitability by principal component analysis (PCA). The identified variables were further used in a cluster analysis (k-means). Stepwise regression was applied to investigate factors associated with HbA1c and MNSI scores. For passive torque analyses, three groups of men (n=49) of similar age were studied, 17 with DM2 without DPN, 15 with DM2 and DPN, and 17 control subjects without DM2. Knee flexion and extension passive torque as well as ankle dorsiflexion and plantar flexion were assessed on an isokinetic dynamometer, followed by passive torque and passive stiffness calculation. The absence of muscular activity during the tests was determined by electromyography (EMG). Results: Concentric knee flexion and extension and isometric ankle extension torques characterized 88.59% of the individuals, forming Cluster 1 (n=29 controls) and Cluster 2 (n=59 DM2). HbA1c was associated with lower torque and higher IL-6, and MNSI score with lower torque and higher TNF-α and IL-6. Subjects with DM2 and DPN exhibited greater knee extension passive stiffness (p<0.01) as well as increased passive torque and stiffness during dorsiflexion and plantar flexion (p<0.04) at 5o /s when compared to controls and those with DM2 without DPN. Conclusion: Concentric knee and isometric ankle torques discriminated between subjects with and without DM2. However, knee and ankle torque reductions associated with DPN, poor glycemic control, and subclinical inflammation were not sufficiently significant to differentiate between DM2 individuals with and without DPN. Individuals with DM2 and DPN present higher knee and ankle stiffness and passive torque in comparison to those with DM2 without DPN and the controls. The mechanical impairments in ankle viscoelastic structures were most evident and more easily assessed at low speeds.A literatura aponta uma forte relação entre as alterações musculoesqueléticas e a incidência de diabetes mellitus tipo 2 (DM2). Ainda não está claro se a DM2 afeta as propriedades passivas do sistema musculoesquelético, aumentando a rigidez e prejudicando a função muscular destes indivíduos. Objetivo: Analisar se os torques concêntrico e isométrico podem distinguir indivíduos com DM2 e neuropatia diabética periférica (NDP) de indivíduos sem DM com a mesma idade e características antropométricas e também, analisar o torque e a rigidez passiva em indivíduos com DM2, com e sem NDP, nos movimentos de flexão e extensão do joelho e do tornozelo, comparados com indivíduos sem DM. Métodos: Oitenta e oito participantes foram analisados, sendo 29 controles, 59 DM2 (23 com e 36 sem NDP). O controle glicêmico foi determinado pela HbA1C e a NDP foi analisado utilizando um sistema baseado no protocolo Michigan Neuropathy Screening Instrument (MNSI). O nível sérico das citocinas inflamatórias IL-1β, TNF-α e IL-6 foi analisado através do método de enzyme-linked immunosorbent assay (ELISA). Os picos de torque identificadas na análise de componente principal (ACP) foram utilizadas para a análise de cluster (k-means). Uma análise de regressão múltipla foi aplicada para investigar os fatores associados com HbA1c, citocinas inflamatórias e o escore do MNSI. Para a análise do torque passivo, três grupos de indivíduos do sexo masculino (n=49), similares em relação à idade, foram analisados, sendo 17 com DM2 sem NDP, 15 com DM2 e NDP e 17 controles sem DM2. O torque passivo de flexão e extensão do joelho e tornozelo foi avaliado com um dinamômetro isocinético à 5°/s, 30°/s e 60°/s, e posteriormente foi calculado a rigidez passiva utilizando o registro dos torques passivo. Resultados: O torque concêntrico de flexão e extensão do joelho e isométrico de extensão do tornozelo caracteriza 88.59% da condição clínica dos grupos, formando o Cluster 1 (n=29 controles) e o Cluster 2 (n=59 DM2). Maiores percentuais de HbA1c foi associado com o menor torque concêntrico de flexão e extensão do joelho e isométrico de extensão do tornozelo e maiores níveis de TNF-α e IL-6 e maior score do MNSI. Em relação à análise da rigidez, indivíduos com DM2 e NDP apresentaram maior torque passivo de extensão do joelho (p<0.01) e assim também um torque passivo e rigidez aumentada durante a dorsiflexão e flexão plantar (p<0.04) a 5o /s, quando comparado com controles e indivíduos DM2 sem NDP. Conclusão: Torques concêntrico e isométrico do tornozelo podem diferenciar indivíduos com e sem DM2, mas não aqueles com e sem NDP. O torque reduzido nos movimentos do joelho e tornozelo estão associados com os sintomas da NDP, o pobre controle glicêmico e a inflamação subclínica aumentada. Indivíduos com DM2 e NDP apresentam maior rigidez e torque passivo do joelho e tornozelo, comparado com indivíduos DM2 sem NDP e controles sem DM2.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)CNPq: 302169/2018-0CAPES: 1662695 - 001CAPES: Código de Financiamento 001FAPESP: 2017/09050-1FAPESP: 2019/07563-7engUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Fisioterapia - PPGFtUFSCarAttribution-NonCommercial-NoDerivs 3.0 Brazilhttp://creativecommons.org/licenses/by-nc-nd/3.0/br/info:eu-repo/semantics/openAccessDiabetesMúsculo esqueléticoCitocinasMembros inferioresTornozeloJoelhoRigidez articularDiabetes mellitusSkeletal muscleCytokinesLower limbAnkleKneeJoint stiffnessCIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONALRelação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periféricaRelationship of rigidity and joint touch with Diabetes type 2 mellitus and peripheral neuropathyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis60015e61dfb-577e-4f3c-b5a5-8574f316a362reponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARORIGINALTESE_pos banca.pdfTESE_pos banca.pdfversão completa da teseapplication/pdf3924419https://repositorio.ufscar.br/bitstream/ufscar/14652/1/TESE_pos%20banca.pdf8861cd6c7745fb961a0573894329feacMD51Carta-comprovante-da-versão-final-de-teses-e-dissertações.pdfCarta-comprovante-da-versão-final-de-teses-e-dissertações.pdfCarta-comprovante da versão final da tese, assinada pelo orientadorapplication/pdf116169https://repositorio.ufscar.br/bitstream/ufscar/14652/3/Carta-comprovante-da-vers%c3%a3o-final-de-teses-e-disserta%c3%a7%c3%b5es.pdf07113d13af3c1d96b3a496fef592aebfMD53CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufscar.br/bitstream/ufscar/14652/4/license_rdfe39d27027a6cc9cb039ad269a5db8e34MD54TEXTTESE_pos banca.pdf.txtTESE_pos banca.pdf.txtExtracted texttext/plain168831https://repositorio.ufscar.br/bitstream/ufscar/14652/5/TESE_pos%20banca.pdf.txtff3064033c12547bb1576d634ce057a6MD55Carta-comprovante-da-versão-final-de-teses-e-dissertações.pdf.txtCarta-comprovante-da-versão-final-de-teses-e-dissertações.pdf.txtExtracted texttext/plain1374https://repositorio.ufscar.br/bitstream/ufscar/14652/7/Carta-comprovante-da-vers%c3%a3o-final-de-teses-e-disserta%c3%a7%c3%b5es.pdf.txt4e7b1061b9a8759974b038ed923dd129MD57THUMBNAILTESE_pos banca.pdf.jpgTESE_pos banca.pdf.jpgIM Thumbnailimage/jpeg6780https://repositorio.ufscar.br/bitstream/ufscar/14652/6/TESE_pos%20banca.pdf.jpg682e1985ed2f0c1c875f9bfbc9dc6941MD56Carta-comprovante-da-versão-final-de-teses-e-dissertações.pdf.jpgCarta-comprovante-da-versão-final-de-teses-e-dissertações.pdf.jpgIM Thumbnailimage/jpeg9445https://repositorio.ufscar.br/bitstream/ufscar/14652/8/Carta-comprovante-da-vers%c3%a3o-final-de-teses-e-disserta%c3%a7%c3%b5es.pdf.jpg56f578841979a0486e4143549b2a2141MD58ufscar/146522023-09-18 18:32:13.408oai:repositorio.ufscar.br:ufscar/14652Repositório InstitucionalPUBhttps://repositorio.ufscar.br/oai/requestopendoar:43222023-09-18T18:32:13Repositório Institucional da UFSCAR - Universidade Federal de São Carlos (UFSCAR)false |
dc.title.por.fl_str_mv |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
dc.title.alternative.eng.fl_str_mv |
Relationship of rigidity and joint touch with Diabetes type 2 mellitus and peripheral neuropathy |
title |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
spellingShingle |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica Ferreira, Jean de Paula Diabetes Músculo esquelético Citocinas Membros inferiores Tornozelo Joelho Rigidez articular Diabetes mellitus Skeletal muscle Cytokines Lower limb Ankle Knee Joint stiffness CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
title_short |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
title_full |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
title_fullStr |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
title_full_unstemmed |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
title_sort |
Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica |
author |
Ferreira, Jean de Paula |
author_facet |
Ferreira, Jean de Paula |
author_role |
author |
dc.contributor.authorlattes.por.fl_str_mv |
http://lattes.cnpq.br/7404427274731262 |
dc.contributor.author.fl_str_mv |
Ferreira, Jean de Paula |
dc.contributor.advisor1.fl_str_mv |
Salvini, Tânia de Fátima |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/4391969032505723 |
dc.contributor.advisor-co1.fl_str_mv |
Serrão, Paula Regina Mendes da Silva |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/2917658715637353 |
dc.contributor.authorID.fl_str_mv |
840e33c2-d641-41c5-a7bf-1f2f3a449611 |
contributor_str_mv |
Salvini, Tânia de Fátima Serrão, Paula Regina Mendes da Silva |
dc.subject.por.fl_str_mv |
Diabetes Músculo esquelético Citocinas Membros inferiores Tornozelo Joelho Rigidez articular |
topic |
Diabetes Músculo esquelético Citocinas Membros inferiores Tornozelo Joelho Rigidez articular Diabetes mellitus Skeletal muscle Cytokines Lower limb Ankle Knee Joint stiffness CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
dc.subject.eng.fl_str_mv |
Diabetes mellitus Skeletal muscle Cytokines Lower limb Ankle Knee Joint stiffness |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
description |
The literature indicates a strong relationship between musculoskeletal losses and the incidence of type 2 diabetes mellitus (DM2), and it is also unclear whether DM2 affects the passive properties of the musculoskeletal system, increasing the muscle stiffness and impairing the function of these individuals. Objective: To analyze whether concentric and isometric torques can distinguish between individuals with DM2 and peripheral diabetic neuropathy (DPN) from individuals without DM2 with the same age and anthropometric characteristics, and also to analyze the passive torque and passive stiffness in DM2 individuals, with and without NDP at the knee and ankle flexion and extension compared to individuals without DM. Methods: Of the 88 participants, 29 were controls, 59 with DM2 (23 with and 36 without DPN). Glycemic control was determined by HbA1C and DPN by the Michigan Neuropathy Screening Instrument (MNSI). Concentric and isometric torque during knee and ankle flexion and extension were assessed by isokinetic dynamometry and torque suitability by principal component analysis (PCA). The identified variables were further used in a cluster analysis (k-means). Stepwise regression was applied to investigate factors associated with HbA1c and MNSI scores. For passive torque analyses, three groups of men (n=49) of similar age were studied, 17 with DM2 without DPN, 15 with DM2 and DPN, and 17 control subjects without DM2. Knee flexion and extension passive torque as well as ankle dorsiflexion and plantar flexion were assessed on an isokinetic dynamometer, followed by passive torque and passive stiffness calculation. The absence of muscular activity during the tests was determined by electromyography (EMG). Results: Concentric knee flexion and extension and isometric ankle extension torques characterized 88.59% of the individuals, forming Cluster 1 (n=29 controls) and Cluster 2 (n=59 DM2). HbA1c was associated with lower torque and higher IL-6, and MNSI score with lower torque and higher TNF-α and IL-6. Subjects with DM2 and DPN exhibited greater knee extension passive stiffness (p<0.01) as well as increased passive torque and stiffness during dorsiflexion and plantar flexion (p<0.04) at 5o /s when compared to controls and those with DM2 without DPN. Conclusion: Concentric knee and isometric ankle torques discriminated between subjects with and without DM2. However, knee and ankle torque reductions associated with DPN, poor glycemic control, and subclinical inflammation were not sufficiently significant to differentiate between DM2 individuals with and without DPN. Individuals with DM2 and DPN present higher knee and ankle stiffness and passive torque in comparison to those with DM2 without DPN and the controls. The mechanical impairments in ankle viscoelastic structures were most evident and more easily assessed at low speeds. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020-01-20 |
dc.date.accessioned.fl_str_mv |
2021-07-22T12:28:23Z |
dc.date.available.fl_str_mv |
2021-07-22T12:28:23Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
FERREIRA, Jean de Paula. Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica. 2020. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2020. Disponível em: https://repositorio.ufscar.br/handle/ufscar/14652. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufscar.br/handle/ufscar/14652 |
identifier_str_mv |
FERREIRA, Jean de Paula. Relação da rigidez e do toque articular com a Diabetes mellitus do tipo 2 e a neuropatia periférica. 2020. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2020. Disponível em: https://repositorio.ufscar.br/handle/ufscar/14652. |
url |
https://repositorio.ufscar.br/handle/ufscar/14652 |
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eng |
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eng |
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600 |
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Attribution-NonCommercial-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nc-nd/3.0/br/ info:eu-repo/semantics/openAccess |
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Attribution-NonCommercial-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nc-nd/3.0/br/ |
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openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de São Carlos Câmpus São Carlos |
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Programa de Pós-Graduação em Fisioterapia - PPGFt |
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UFSCar |
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Universidade Federal de São Carlos Câmpus São Carlos |
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